NO DOC FIX PAY-FOR YET — The Energy and Commerce Committee is moving ahead on legislation to undo Medicare’s much-maligned system for reimbursing doctors without addressing a major element: how to pay for it. The health subcommittee next week will mark up a bill to replace the flawed Sustainable Growth Rate formula, but Hill and lobbying sources say they don’t expect to see an offset for the $139 billion price tag until the legislation hits the House floor. Though pretty much everyone wants to scrap the existing reimbursement system and replace it with quality-based payments, Democrats and Republicans have long disagreed on how to fund SGR repeal. The POLITICO Pro story: http://politico.pro/10X2Ren

Story Continued Below

WHERE IN THE WORLD IS KATHLEEN SEBELIUS? – The HHS secretary will be in Orlando this morning, the second stop on her Obamacare summer tour. Sebelius, who was in Phoenix last week, said she is trying to hit a different city each week to raise awareness of the law. She’s scheduled to address the NAACP conference this afternoon.

Happy Tuesday and welcome to PULSE, where we’re unfortunately not filing this from our pool.

“Orlando! Sea World and PULSE and putt-putt golfing”

WITH EXCEPTIONS, CONSERVATIVE LEADERS BACK MANDATE DELAYS – Leaders of 18 conservative groups are backing the House bills delaying Obamacare’s employer and individual mandates by a year. “If the employer mandate can be delayed a year, so can (and should) the individual mandate … we view this effort as not only a matter of basic fairness, but part and parcel of our larger efforts to defund and repeal Obamacare,” wrote the groups in a Monday letter. Notably missing from the letter are Heritage Action and Club for Growth, who have been critical of ACA bills that don’t repeal the whole law. The letter: http://politico.pro/12BDfoB

--HOUSE RULES COMMITTEE MEETS ON MANDATE BILLS — The panel meets at 5 p.m. on separate bills delaying the employer and individual mandates: http://1.usa.gov/14O0oDG. The House vote is Wednesday.

COUNTDOWN TO OCT. 1: 77 days.

MINI-MEDS ARE DEAD. LONG LIVE ‘SKINNY PLANS?’ – The Obama administration has given its blessing to employers who want to offer pared down coverage known as skinny plans that will help them escape at least some of the employer mandate penalties. And some businesses are going to do just that next year, mandate delay notwithstanding, industry consultants say. The skinny plans are the descendant of mini-meds, designed to meet the health care law’s requirement to cover preventive services without any co-pays and benefit caps. But those are about the only standards you need to meet to escape the $2,000 per employee penalty on large employers that don’t offer insurance. The limited plans only cost $50 in premiums a month — a relatively cheap option that can be borne by the employers or their workers.

--The Obama administration has given the plans its blessing, even though they would not protect individuals from medical bills that could cause financial ruin in the case of severe injury or illness. Treasury officials tell PULSE that’s partially because people can seek out better exchange coverage, where lower income workers will be eligible for subsidies. For each employee who receiving an exchange subsidy, large employers will pay a $3,000 penalty. The plans are expected to be especially attractive to companies that provide mini-meds to about 1.4 million workers, as well as those considering offering coverage for the first time. The Pro story: http://politi.co/15JyFoV

GAO FINDS HIGHER SELF-REFERRALS — Medicare doctors ordered far more anatomic pathology tests and procedures when they benefit financially, according to a GAO report released by Sens. Max Baucus and Chuck Grassley and Reps. Sandy Levin and Henry Waxman. The GAO report estimated that Medicare in 2010 doled out $69 million for 918,000 extra treatments by self-referring providers. Three provider specialties — dermatology, gastroenterology and urology — accounted for 90 percent of self-referrals, the report found. The lawmakers said the GAO’s findings bolster the case for paying providers by quality of care, not just quantity. The report: http://1.usa.gov/1463jKc

--A BIG YAWN FROM HHS? – HHS told GAO it’s reduced payments for the service by 30 percent and “significantly reduced” the financial incentive to self-refer for those services, but GAO said the department still didn’t address the watchdog’s concerns. The GAO writes: “On the basis of HHS’s written response to our report, we are concerned that HHS does not appear to recognize the need to monitor the self-referral of anatomic pathology services on an ongoing basis and determine those services that may be inappropriate or unnecessary.”

** A message from WellPoint Does the future of America’s health care system start with personalized care, innovative care and preventive care? We THINK so. By partnering with Fortune 50 technology companies, physician groups and community health organizations, WellPoint supports innovative programs that deliver 21st century solutions for today’s health care challenges. **

NEW YORK FED: ACA MOSTLY BUSINESS AS USUAL – Three in four New York businesses are expecting to keep their same health plans under the ACA, according to a Monday report from the New York Federal Reserve. About the same rate of firms say they haven’t made significant staffing changes because of the law, while 65 percent don’t expect major changes in the coming year. About 11 percent said they were planning to cut back or drop health insurance. The report: http://bit.ly/1456Ok8

ADMINISTRATION TO BLAME STATES FOR NOT EXPANDING MEDICAID – Not able to get expanded Medicaid? The Obama administration plans to blame the states for that, according to the Huffington Post. “When Americans begin shopping for benefits on the law's health insurance exchanges on Oct. 1, the people who would qualify for Medicaid but live in the 20-plus states where Republican governors or state legislators won't approve the expansion will see a note explaining that federal law allows them to get coverage that their states' leaders won't provide them,” the HuffPo reports. A senior administration official disclosed that nugget in a recent background briefing with the HuffPo and other left-leaning outlets. Their story: http://huff.to/17gamhx

ACA LOOMS OVER MONTANA SENATE RACE – As Montana Insurance Commissioner Monica Lindeen ponders a run for the state’s open Senate seat, opponents are already labeling her “the candidate of Obamacare” over her support of a state-run exchange. “She has been on the front lines of the effort to force Montanans to accept it,” said Bowen Greenwood, head of the Montana GOP. Lindeen counters that she’s worked hard to keep state control over health care. The Pro story: http://politico.pro/12sFF5x

NORTH DAKOTA ABORTION LAW BLOCKED — A district court judge has ruled that a 2011 North Dakota law limiting the use of drugs to terminate pregnancy violates the state and federal Constitutions. The Center for Reproductive Rights brought the case, and the group is challenging another set of abortion restrictions that it says would shut down North Dakota’s only abortion provider. The ruling: http://politico.pro/146gJWG

LAUNCHING MONDAY — MORNING EDUCATION: Looking for the best coverage of federal and state education policy? POLITICO Pro is launching its latest morning newsletter — Morning Education — on July 22. The newsletter will cover everything from student loans to K-12 federal policies to state-level education policy disputes, and much more. To sign up for the best education coverage in Washington, email info@politicopro.com.

REPORT: CMS APPROVES NEW MEXICO MEDICAID PLAN – The Obama administration has approved New Mexico Gov. Susana Martinez’s Medicaid reform plan, which includes some co-pays and efforts to better track medical services, according to the AP. Eligibility and reimbursement rates will remain the same, while some patients will pay $3 for brand name drugs and could pay up to $50 for each emergency room visit. The AP story: http://bit.ly/146luiW

TOMBLIN: MORE QUESTIONS ON MEDICAID, EXCHANGES – West Virginia Gov. Earl Ray Tomblin sent HHS 10 more ACA questions on Monday, citing tight deadlines and incomplete guidance as a source of anxiety. “It remains a critical concern that the currently incomplete rules and guidance will not support a successful implementation of the federal mandated PPACA,” the Democrat urged. His letter: http://bit.ly/12Rg3iA

HEALTHCARE LIGHTHOUSE OPENS TODAY—Healthcare Lighthouse, an aggregator health policy website, opens today. Thorn Run Partners executive Billy Wynne developed and founded the site, which will aggregate health care policy news for a subscription fee. “The goal is to be a one-stop shop for people interested in tracking federal health care policy,” said Wynne, who will serve as Healthcare Lighthouse CEO. “We pull from over 80 sources ranging from government regulations and guidance to think tank reports to press stories.” The group’s board members include former CMS administrator Tom Scully and former Obama administration health policy advisory Liz Fowler, among others. There’s a launch party tonight on Capitol Hill.

WHAT WE’RE READING

New data to be released today shows that all 32 Pioneer ACOs improved patient care on quality measures, but just 18 managed to lower costs for Medicare beneficiaries they treated, the Wall Street Journal reports. http://on.wsj.com/13oagjC

The FDA approved the first brain wave scanner that can help diagnose attention deficit hyperactivity disorder in children, The Associated Press reports. http://bo.st/13eur7O

The Rhode Island exchange announced a new name, logo and outreach effort on Monday, the Providence Journal writes. http://bit.ly/18jMRJ1

Michigan state senators return to the Capitol this week to discuss the Medicaid expansion, MLive writes. http://bit.ly/13lMqF9

The medical device industry says they’ve already paid out $1 billion in the ACA’s new tax on its manufacturers, the Minnesota Star Tribune reports. http://bit.ly/18kBctq

A new study finds that retiring later in life could lower the risk of developing forms of dementia, USA Today writes. http://usat.ly/16EdHVn

** Improving America’s health care — and helping control cost — starts with improving the quality of care. For WellPoint, this means delivering personalized, innovative and preventive care. Through the CareMore program, we help deliver customized care to meet individual health needs and help manage chronic disease. Working with IBM Watson, we equip busy doctors with the latest clinical research and treatment options to help improve the quality of care delivered to individual patients. And, with the Patient-Centered Primary Care program, we empower doctors to coordinate care and enable them to spend more time with their patients. But we know improving America’s health care must expand in the future. That’s why we’re launching a new partnership this year with medical schools, residents and young physicians — the future of America’s health care system. To learn what we THINK it takes to make a better health care system visit ThinkWellPoint.com. **

** A message from PhRMA: Diabetes is a complex disease affecting more than 30 million Americans – with one-in-ten living in DC, Maryland and Virginia having the disease. Thanks to advances in diabetes care, patients around the country are living longer, healthier lives. Take five-year-old Rhys for example [link to his I’m Not Average profile]. He was diagnosed with type 1 diabetes at 15-months-old, but today, he is a thriving young boy. This is due in large part to new and innovative medicines developed by researchers and scientists at America’s biopharmaceutical companies. Learn more about the medicines in development for diabetes here. **

Authors:

About The Author

Jason Millman is POLITICO Pro’s associate health care editor. He’s on his second tour of duty at POLITICO after a stint at the Washington Post’s Wonkblog and has covered health care since graduating from Boston University with a journalism degree in 2008.